RCPCH launches vitamin D campaign

Rickets describes a condition where bones are abnormally weak and the skeletal structure is thus compromised. It used to be visually observable in Victorian times, as children suffering from malnutrition would exhibit ‘bow legs’ – curved deformity in their limbs. Today’s cases more typically manifest themselves in bones breaking easily, rather than visual signs. Rickets is a sign of vitamin D deficiency. There are two minerals that are also vital for bone health – calcium and phosphorus. Phosphorus needs vitamin D for its absorption, so these three nutrients work together to determine bone health. They are usually found in the same foods (meat, eggs, dairy products), which is nature’s way of ensuring that we get the nutrients that we need to complement each other.

We know that vitamin D is one of our most vital nutrients – we are continually learning more about this particular vitamin. We know enough already to be sure that it plays a critical protective role in heart disease and cancer, as well as the more obvious osteoporosis and the less obvious mental health.

Cases of rickets have apparently risen fourfold since the mid-1990’s (from 183 to 762). Far more worryingly, the RCPCH reports that half of Britain’s white population, up to 90% of the ethnic population and a quarter of children are suffering from vitamin D deficiency.

Cholesterol and vitamin D

In our war on cholesterol we seem to have forgotten a critical route by which vitamin D is made – sunshine synthesises cholesterol in the skin and turns it into vitamin D. If we lack sunshine, or cholesterol, or both, we have impaired ability to make vitamin D. We can also obtain vitamin D from food, but we have demonised the foods most abundant in this vital nutrient: red meat, fatty fish, eggs and dairy products. Three ‘health’ dictats have thus contributed to the return of a disease that should have died with the Victorian era: 1) lower cholesterol 2) avoid dietary fat 3) don’t go out in the sun and/or cover up with clothing/factor cream if you do.

Ellen, in her Guardian article, wrote “No one seems to know why there is such a high incidence among certain ethnic groups.” If she had not been so quick to decide that rickets is about poverty, rather than lack of sunshine, the rationale for the ethnic dimension is obvious. Indigenously, darker skin people live nearer the equator and lighter skin people live further away from the equator. This is evolution. Those nearer the equator get more sunshine, but their darker skin lets less through to synthesise into vitamin D. Fair skinned Scandinavians get less sunshine, but their lighter skin allows more cholesterol to be synthesised into vitamin D.

The RCPCH position statement notes that “Sunshine (via skin photosynthesis) is the main natural source of vitamin D in humans. In the UK, vitamin D can only be made in our skin by the action of sunlight during the summer-time, and only during the middle of the day when the sun is high in the sky.”

Birmingham is the latitude, North of which we understand that sunshine is insufficient to provide any skin synthesis of cholesterol into vitamin D during the winter months. Hence any darker skinned people living in Birmingham, or further North anywhere in the world, are unable to make vitamin D during the winter time. They need to cover this with dietary intake in the winter months and get optimal sun exposure during the summer months. This doesn’t happen. Asian women particularly, cover themselves up all year round and deny themselves the gift that the sun is trying to give them.

Knowing the role that vitamin D plays in heart disease helps us to understand why Asians and black people, living outside their country of ethnic origin, suffer substantially higher heart disease. They literally have the wrong skin colour for their environment, reducing access to vitamin D. The ultimate irony is that the known higher incidence of heart disease in ethnic populations will have doctors place such people on cholesterol lowering medication and a low-fat diet and this will further reduce their chance of obtaining the very nutrient that they are missing. Our public health advice is bad enough for Anglo Saxons. For those of other ethnic origins, it is a death sentence.

The RCPCH call to action

We have brought this illness upon ourselves and the RCPCH should have pointed this out. Instead they listed nine points for action. You can see them for yourself in the position statement. They can be summarised as follows – my comments are below each recommendation.

1) We need more research.

No we don’t. We know how utterly vital vitamin D is not just for bone health, but for entire human health. The Department of Health[i], Dietary Reference Values for Food, Energy and Nutrients for the UK does not even have complete listings for the vitamin D Reference Nutrient Intake for adults. Where recommendations are made, the recommended daily intake is 10mcg. The USA recently revised their vitamin D Recommended Dietary Allowance (RDA) upwards from 10mcg to 15mcg.

The 2010 Family Food Survey[ii] reports that average UK vitamin D intake is 3.12mcg. We therefore have government evidence of substantial deficiency. (This survey is available annually and this deficiency has been observable for many years). Further research is not needed. We should revise the UK RDA upwards to 15mcg and take immediate steps to encourage sun exposure, cease all lowering of cholesterol and ensure that animal foods form the staple part of human diets.

2) Do surveillance to further understand the problem.

Research/surveillance – same difference. This is unnecessary procrastination. See the response to (1).

3) We should take supplements.

We don’t need supplements. We need to stop demonising fat, cholesterol and sunshine.

4) Paediatricians must work closely with other health professionals in ensuring optimal nutritional health of the foetus, infant and child.

Yes – by ceasing the demonisation of fat, cholesterol and sunshine.

5) Wait for the Scientific Advisory Committee on Nutrition, to report in relation to dosages and timing of supplements and wider food fortification.

No – this is the same as points (1) and (2). We have enough information. Don’t delay and act now.

6) Fortify fake foods.

This beggars belief. The position statement notes that margarine, infant formula milk and some breakfast cereals are fortified with vitamin D. Can we really be saying eat fortified, (hydrogenated), emulsified, bleached, deodorised and coloured margarine, with synthetic vitamin D added, instead of butter, which comes naturally with vitamin D? Can we really be saying that we should have sugary cereal, with synthetic vitamin D added, instead of eggs for breakfast, which come naturally with vitamin D? Can we really be saying that babies and toddlers should be having fake food (infant formula) during their most critical years, instead of breast milk and blended real food?

In my book The Obesity Epidemic: What caused it? How can we stop it?I analyse an infant formula. The composition of Similac Isomil Advance, Soy Formula is 50% corn syrup, 14.2% soy protein isolate, 10.4% high oleic safflower oil, 9.7% sucrose, 8.2% soy oil and 7.5% coconut oil.[iii] If a baby is unfortunate enough not to be breastfed, the infant can be started on a diet of 60% sugar from the first moment something is put in its mouth

7) Make single vitamin D supplements – because vitamin D/A combinations are bad for pregnant women.

Puh-lease! The same government data that shows serious deficiency in vitamin D also confirms that we are deficient in retinol – the form in which the body needs vitamin A. We should not lose any sleep thinking that anyone in the UK is getting too many nutrients, let alone pregnant women with even higher nutrient requirements than average.

This point is also the same as (3) – take supplements. The answer is thus the same – no – just stop demonising fat, cholesterol and sunshine.

8) Use the “Healthy Start” programme to get supplements into children.

No – just stop demonising fat, cholesterol and sunshine

9) Practical signposting should be made to paediatricians about best guidance on treatment and prevention to-date and learning opportunities, specifically the RCPCH e-learning and teaching sessions on nutrition.

The RCPCH advice can be summed up as 1) get more information and 2) get supplements into people. On this basis, the less well known the RCPCH advice is the better!

I reiterate. We need to stop demonising fat, cholesterol and sunshine and promote all three as healthful instead.

Dietary sources of vitamin D

For those winter months when we don’t have access to the sun and for optimal vitamin D intake at all times, we need to consume vitamin D in our diets. Dairy products are good sources of vitamin D. Oily fish is better. Sardines have approximately 7 times the vitamin D levels of whole milk and over 20 times the levels in hard cheese (and hard cheese is better than soft cheese for the bone nutrients generally).

200g of sardines (a medium sized tin) would give nearly 15mcg of vitamin D in one go. Other oily fish are excellent sources of vitamin D (herring, halibut, catfish, salmon, mackerel etc), but sardines are exceptional. Vegetarians would need to eat 26 medium eggs each day (1,634 calories) to get 10mcg of vitamin D. Mushrooms, which have been exposed to sunlight, are the only conceivable option for vegans. Over two kilograms of such mushrooms would need to be sourced and eaten daily to deliver 10mcg of vitamin D. Ideally, but not an option for vegans, these would need to be consumed with butter to make them ‘bio-available’ to the body.

The final important point to note about dietary vitamin D is that it comes in two forms – D2 and D3. D2 comes from plant sources (like the mushrooms mentioned above). D3 only comes from animal sources. This is the form that has been shown to have the most health benefits for humans.[iv] Supplements tend to be in the form of D2 and are therefore no substitute for the red meat, eggs and butter that we have shunned.

Vitamin A is the same – it comes in the form of carotene from plants and retinol from animal foods and retinol is the form needed by the body. Vitamin K has a plant form (K1) and an animal food form (K2). The latter is the one most needed. It was researching nutrition to this level that ended my 20 year period as a vegetarian.

If we want to be healthy we need to eat animals and we need to get out in the sunshine. It’s what we evolved to do and rickets is a terrible reminder of how far removed from our evolutionary roots we have come. RCPCH we do not need more information or supplements. We need to stop demonising the cholesterol that our body is trying to make and to stop demonising the dietary fat and the sunshine that has sustained us since time began.

[i] The Department of Health, Publication 41, Dietary Reference Values for Food, Energy and Nutrients for the UK, published by The Stationery Office

18 comments on “RCPCH launches vitamin D campaign”

Hi Zoe – I do greatly respect your work but on this one, I have to strongly disagree.

It is very difficult in the UK and even more so in Scotland, where I live, to obtain adequate amounts of Vitamin D from food and sunshine.

The Scottish Government recognises that the majority of the population is likely to be deficient. Research has linked low Vitamin D levels to the high incidence of Multiple Sclerosis in Scotland and the highest levels in the world in the Orkney & Shetland Isles.

There is also mounting evidence that Vitamin D can prevent breast cancer and other cancers and also boost the immune system and help prevent the flu and other infections. This research is also finding that the level of Vitamin D needed to provide these benefits are higher than the current recommended levels which were set to prevent rickets only.

I had my levels checked last year and found that at the end of August, my level was 22ng/ml which is just enough according to the NHS level set to prevent rickets. However, that would mean that over the months of October through to April I would have received no Vitamin D from the sun and it is extremely likely that I was becoming deficient every winter. This is likely to explain lifelong aches and pains in my legs and arms and the poor state of my adult teeth which were soft and crumbling when they first came in in adolescence and also the frequent and persistent colds, coughs I suffered every winter.

After getting my levels tested, I began taking a high does of Vitamin D (10,000 IU) through the winter months and am now continuing taking 5000 IU through the summer as it is nearly always cloudy/rainy where I live (check the BBC weather forecast for North West Scotland).

The aches and pains in my legs and arms have gone and I did not suffer one bad cold or flu all winter though many around me suffered numerous and prolonged illnesses.

In conclusion, I think ideally it would be best if we could get our Vitamin D needs met by diet and sunshine but for many/most people this is not possible and supplementation is the best solution. Vitamin D3 is very easy to obtain.

If you take an average quantity of vitamin D for dairy products, you will see that you would have to eat 1kg of them each days, to obtain a poor 5µg, the vitamin D in dairy is not correlate with plasmatic levels, the levels of active vitamin D are decreased and same thing for parathyroid hormones when the blood levels of calcium are increased. The more you eat, the more you release. Same goes for fishes you can’t eat 1kg of sardines a day or 150g of red salmon, unless you got a lot of money.
Vitamin D2 in supplements REALY… people can see for themselves in grocery stores or chemist store.
I can make a mistake but I am belgian and in my country, the most common and easy to get is D3.

Hey Dave why are you commenting on something you no anything about
please go back to reading cereal boxes and trusting the Government…ps
exactly who’s the (Idiot) not my word yours.
Hey Zoë Thanks for the Great research living proof that this life style works.
Chad
Vancouver Canada.

An interesting article. You mention how ” Supplements tend to be in the form of D2″, however, in my experience, D3 supplements are freely available in chemists and health food shops. Boots own brand supplements, for example, are D3.

The prosecution of Rohan Wray and Chana Al-Alas was an absolute catastrophe. How can such catastrophic prosecutions be prevented in the future? Of course, it is the police and the Crown Prosecution Service (CPS) that bring such cases to trial. However, in the case of allegations of child abuse, a prosecution will only be brought with evidence provided by doctors. In the case of Shaken Baby Syndrome, otherwise known as Abusive Head Trauma (AHT), the doctors who currently advise the CPS are the hawks, the ‘dirty thinkers’, who believe that ‘The Triad’ (retinal haemorrhages, subdural bleeding and encephalopathy) indicates abusive head trauma, without the need for any additional supporting evidence of that abuse.

It still seems to be CPS policy to resist challenges to the ‘Triad’ based on any possible alternative pathological mechanisms, which might arise, for instance, as a consequence of vitamin D deficiency. This must change if such dreadful proceedings are to be avoided in the future, as William Bache suggested in his letter to The Times of 23 April 2012. The text of his letter is as follows:

DISCARD SHAKEN BABY THEORY

“Sir, I was the solicitor for Rohan Wray during the course of the criminal proceedings against him in which he was alleged to have murdered his four-and-a-half-month-old son Jayden (report, Apr 20).

At University College Hospital, London, and later at Great Ormond Street Hospital, as soon as fractures had been detected the immediate reaction of the health professionals was that my client and the child’s mother were abusive parents. They were treated thereafter as though they were criminals.

As a result of the intervention of the police they were prevented from seeing their son or being at their son’s bedside when he died. They were not present at the death. The early assumption that there was abuse distracted those who should have known better from seeking out the real reason for his illness. As a consequence it is likely the treatment that might have saved Jayden was overlooked.

All the official attitudes were obviously inspired by the so-called ‘shaken baby syndrome’ theory. The triad of retinal haemorrhage, subdural haemorrhage and brain swelling was present in this case.

It is high time the shaken baby syndrome theory was discarded. It is becoming increasingly discredited. There can be many other reasons for the triad which have nothing to do with abuse. Slavishly assuming that the triad is strong evidence of abuse will result in yet more inappropriate prosecutions and worse, inappropriate convictions. It will lead to more loving families being torn apart for no good reason.

The only worthwhile scientific truth in these situations is that the best experts simply do not know what really causes some of these deaths. To embark on legal proceedings on the basis of what is still only a theory will continue to lead to untold misery. The Director of Public Prosecutions should revise his guidelines on the subject.”

WILLIAM BACHE
William Bache & Co

It would be a misfortune if all this were to happen again. In my view, it is high time that the Royal Colleges, particularly the RCPCH, reined in the hawks within the medical profession who, along with the police and CPS, have been allowed to abuse their power for too long.

Continuing the dreadful story of a young coloured couple put on trial for murdering their baby …

“A young couple who were in effect tried and cleared twice of shaking their baby son to death called last night for an inquiry into their ‘agonising’ treatment at the hands of social services, the NHS and the police. Rohan Wray and Chana Al-Alas were accused of killing four-month-old Jayden, who died of severe head injuries. While awaiting trial, they lost custody of the little boy’s younger sister, Jayda.”

“Mr Wray said: ‘We feel we were treated very poorly by the state authorities involved in investigating our case. We were viewed as guilty from the outset. ‘They went down the line that we had done this to our son by shaking him. ‘If the doctors had found the rickets problem, we feel our son could still be alive today. But our agony at losing Jayden was exacerbated when we were accused of killing him.’ Police refused to let the couple or their family attend Jayden’s christening, which they requested before his life support machine was switched off. They were not allowed into the paediatric intensive care ward to see him when he died. But the parents said the most heartbreaking moment of their ordeal was when their newborn daughter was taken from them.”

I believe this young couple’s experience provides damning evidence of the dreadful state we’re in over rickets and vitamin D deficiency.

A little known consequence of vitamin D deficiency is a murder charge.

One such case concerned a Londoner, a 16 year old girl with a dark skin. She had a baby by her 19 year old, dark skinned boyfriend – who was overjoyed to be a father despite his youth. The girl breast fed her child. The baby become unwell; the couple took him to the GP who referred them to hospital. They went on the bus. The baby was admitted to their local London hospital, deteriorated and was transferred to the intensive care unit at GOSH where he later died. The young parents were not allowed to be with their child because the doctors had diagnosed deliberate abuse by parents. A post-mortem examination revealed rickets. Two years later the young couple were up at the Old Bailey defending a murder charge.

There were 60 medical experts present as witnesses. No doctor really knew why the child had died, but a jury was expected to decide on murder beyond reasonable doubt, or otherwise. After six weeks the trial was called off. Judge Stephen Kramer QC told the jury: “There is insufficient evidence for you to be asked to continue.” The trial probably cost the taxpayer around £3 million, though the financial is a small part of the true cost.

I regularly read your blog and commend you on the work you have done in the analysis of poor quality science and countering much of the conventional wisdom based on such science. I agree with your position on Vitamin D in this post and that we should as far as possible get it from sufficient sun exposure and real food.

I also totally agree that infants should preferably be breast fed and like adults be fed solids derived from real food. Industrial “food” for babies should not be promoted as a some kind of convenient “choice”. However, these products do have uses for situations where, despite optimal support, a mother is really unable to breastfeed or for the very rare condition of congenital lactase deficiency. The real problem is that they are promoted as a convenience, or in the case of the soy product mentioned, for pseudoscience reasons like “fussy tummies” whatever that is.

That said, I feel compelled to point out that the following statement is both inaccurate and misleading:

“In my book The Obesity Epidemic: What caused it? How can we stop it? I analyse an infant formula. The composition of Similac Isomil Advance, Soy Formula is 50% corn syrup, 14.2% soy protein isolate, 10.4% high oleic safflower oil, 9.7% sucrose, 8.2% soy oil and 7.5% coconut oil.[iii] If a baby is unfortunate enough not to be breastfed, the infant can be started on a diet of 60% sugar from the first moment something is put in its mouth”

4. The misleading part of the statement is twofold. First, you do not state that the composition is for the dry unprepared powder which indeed contains 49% sugar (current formula – perhaps 60% previously). Second you suggest that a baby on this formula is being fed a diet of “60% sugar”. Are you really suggesting that babies eat the dry unprepared powder? I doubt it, but this is the implication.

When the dry powder is mixed with the recommended amount of water the formula actually contains about 7g/100ml of sugar which is the same amount of lactose contained in human breast milk. See: http://archive.unu.edu/unupress/food/8F174e/8F174E04.htm So, by this logic maybe human breast also contains too much sugar? I am certain that you do not really believe this.

The composition of commercial infant formulas is far from ideal,and the promotion of their use outside of situations where breast feeding is clinically impossible should certainly be opposed. However, if we expect alternative views to be taken seriously, it is equally important that care be taken to ensure factual accuracy and avoidance (even if unintentional)of misleading claims.

My book, The Obesity Epidemic: What caused it? How can we stop it? was published in October 2010 and this was a current formula at the time. The original reference is #287 on the obesity epidemic site (http://www.theobesityepidemic.org/references/chapter-14/) This covers points 1 and 2. There is no point 3? The full extract in the book, point 4, notes “of the part that is not water”. Analysing the part that is not water is most relevant as it doesn’t matter how much water is added – the composition of the formula is the composition of the formula and the one I analysed was bad and I don’t imagine your references for more up to date products are much better. However much or little of the formula I analysed was consumed by a baby – the percentage was 60% sugar – corn syrup and sucrose – and I make no apologies for including this disgusting product in my book in the section on childhood obesity.

Hence I stand by the accuracy of my 2010 publication
Very best wishes – Zoe

In previous post, you mentioned that the “five a day” for fruit intake was off target and nobody knows where that recommendation came from. Read this article, referrring to a new report, and expect that the new recommendation will be “ten a day”!

Not to mention many black women are stupidly using and encouraging each other to use sunscreen. We should be the last people to worry about wrinkles (I’ll add though that whilst on holiday in Majorca my poor daughter did burn). I find it interesting that many of my friends and family report better health when they visit the Caribbean. Aches, pain and skin conditions seem to alleviate the closer you get to the equator.

And what about its benefits on weight loss and muscle growth. My entire life I had trouble losing weight. I could never make it to goal… and would usually have to stay on the diet an unusually long time…the first diet I went on with my Vitamin D blood level high, I made goal in 6 months. I am sure this is a major key in the battle against obesity.

It’s so rare to see anyone point out the need for cholesterol to make Vitamin D via sunlight. I try to get all the good fats, cholesterol, and sunlight that I can. Luckily I live where we can get good sunlight year round.

And great point about sardines. In addition to the Vit D, they also have omega-3 fats and B12.

I take vit.D supplements from September to May as here in Sweden we simply do not get enough sun exept from June to August. It helps me get through the dark months and mostly keeps the colds away.
It has also been noted here in recent years that there is an increase in autism in children whose parents are from Somalia. This has been attributed to lack of vitamin D. http://www.dietdoctor.com has extensive articles on Vitamin D.

‘”Writing in Scrubbing Up, Prof Blair said: “Vitamin D can be found in some foods such as oily fish, eggs and mushrooms – but only 10% of a person’s recommended daily amount is found naturally in food.

“Put bluntly, eating more fish and getting out in the sun a bit more won’t make much of a difference to your vitamin D levels.”‘

It is worrying how seemingly intelligent people can miss the obvious: Take a look again at this quote – “…only 10% of a person’s recommended daily amount is found naturally in food.”

A diet that provides only 10% of the recommended amounts of a vital nutrient is clearly not a sustainable diet.

This then raises two possibilities: The fact that humanity been able to survive so many generations on such a deficient level of vitamin D intake could mean that the recommended vitamin D levels are unreasonably high. But then that would negate all the clinical research on required vitamin D levels

Or (much more realistically) it raises very real questions about the nature of the recommended diet itself — and, thus, whether it really should be recommended or not.

Why is it that seemingly intelligent people are unable to draw the obvious inference from their own statements that it is the diet itself that is to blame?

Hi Stephen – great question! I think that Dr Malcolm Kendrick summed it up in a debate thincs were having the other day (The International Network of Cholesterol Sceptics): “When you are defending an idiotic idea you are forced to use other idiotic ideas. It is the nature of the thing.”!
Genius!
Best wishes – Zoe